Beyond Counting Words: Verbal Fluency Components and Executive Functions in Traumatic Brain Injury

ABSTRACT Background Verbal fluency (VF) tasks are consistently included in neuropsychological assessment protocols because they provide a rapid and sensitive measure of lexical retrieval and executive functioning across a wide range of neurological conditions. In addition to considering the number of words produced by the individual, examining other variables can provide highly valuable information about their cognitive performance. Aims This study examines the clinical utility of looking into specific components of VF tasks by comparing the performance of patients with traumatic brain injury (TBI) to that of healthy controls. Method and Procedures Twenty‐seven individuals with TBI and 29 matched controls completed a neuropsychological assessment including phonological and semantic VF tasks, along with measures of processing speed, working memory (WM) and executive functioning. Group differences were analyzed across all variables, and within‐group correlations were explored between VF components (total correct responses, perseverations, mean cluster size, and number of switches) and cognitive processes. Outcomes and Results Significant group differences emerged for all cognitive measures and VF components, except for mean cluster size. In the TBI group, total correct responses on both VF tasks were associated with processing speed and WM measures. Additionally, the number of switches in phonological VF correlated with cognitive flexibility measures, while mean cluster size in semantic VF was related to a measure of WM. In contrast, within the control group, total correct responses and switching in phonological VF, as well as mean cluster size in semantic VF, were associated with WM performance. Conclusions and Implications These findings highlight the sensitivity of VF tasks in detecting cognitive dysfunction following TBI. Importantly, the analysis of qualitative components (such as clustering and switching) provides a more detailed understanding of the executive mechanisms underlying VF performance. Thus, beyond simple word counts, these measures enhance the diagnostic and clinical value of VF tasks as tools for assessing cognitive functioning in both research and applied settings. WHAT THIS PAPER ADDS What is already known on this subject Verbal fluency (VF) tasks, in both their phonological and semantic variations, are simple neuropsychological assessment tools that are sensitive to the cognitive performance of healthy individuals as well as patients with neurological conditions. Previous studies have demonstrated the relationship between this task and cognitive processes related to language, processing speed, and components of executive functions; nevertheless, the evidence remains inconclusive. What this paper adds to the existing knowledge Patients with traumatic brain injury (TBI) and health controls showed distinct patterns of performance across cognitive measures including VF components. In controls, VF indices were mainly associated with working memory (WM), whereas in TBI, total correct responses correlated with WM and processing speed; additionally, switching in phonological VF was linked to cognitive flexibility, and clustering in semantic VF to WM. What are the potential or actual clinical implications for this work? VF tasks should be regarded as complex cognitive measures. Beyond word counts, analyzing qualitative components provides valuable insights into executive processes, thereby enhancing their clinical applicability.